Oropharyngeal and esophageal dysphagias are common in humans and dogs and are classified into 2 broad etiologic categories: structural and neuromyogenic disorders.1–7 Structural causes of dysphagia, including cricopharyngeal bars, esophageal strictures or webs, extrinsic compression, tumors, and foreign bodies, are generally easy to diagnose in dogs; however, diagnosis of neuromyogenic disorders, including neuropathies, myopathies, neuromuscular junctionopathies, and esophageal dysmotility disorders, can be challenging. Conventional assessment of dysphagic dogs includes collection of a thorough history, physical (including oropharyngeal) and neurologic examinations, survey radiography of the thorax and neck, biochemical analyses (including measurement of creatine kinase activity), videofluoroscopy during swallowing, and esophagoscopy. Advanced diagnostic procedures implemented in dysphagic dogs with an underlying neuromyogenic cause include electrodiagnostic testing such as electromyography, nerve conduction velocity testing, and muscle biopsy. Videofluoroscopy is the only diagnostic technique used in veterinary medicine that provides information about the functional integrity of the esophagus.1
Esophageal manometry is the test of choice to evaluate disorders of esophageal motor function. Manometric techniques have evolved immensely since the 1970's, when water-perfused catheters were in use. Those catheters had pressure-sensing ports spaced at wide (3- to 5-cm) intervals. Therefore, a great deal of esophageal pressure data could not be obtained. Water-perfused catheters also had a short sensing segment, making it impossible to simultaneously observe the entire esophageal motor pattern from the pharynx to the stomach. These problems were obviated with the advent of HRM catheters with pressure sensors spaced at 7.5- to 10-mm intervals along a 36-cm sensing segment. This facilitates simultaneous assessment of motor function of the UES, esophagus, and LES with each swallow. Pressure data are converted into a topographical plot to provide a complete spatial and temporal depiction of esophageal motor function termed HREPT.8 In HRM catheters, the small diameter (ranging from 2.75 to 4.2 mm) facilitates the transnasal intubation of the esophagus in fully awake people; thus, they can be evaluated on an outpatient basis.9–13
To our knowledge, HRM has been assessed in dogs, in only 2 studies,14,15 which indicated that HRM is feasible in awake dogs; however, both studies were conducted on Beagles only. Additionally, repeated evaluations in awake, healthy dogs following placebo administration were not performed.14,15 However, no conclusions could be drawn from either study regarding the variability and reproducibility of HREPT in dogs, and the usefulness of several important outcome variables, including residual LES pressure following cisapride administration,15 UES recovery time, and pharyngeal contractile integral, were not assessed.14
The objective of the study reported here was to validate the use of HRM in awake, healthy dogs of various breeds and body sizes and compare the effects of bolus type (liquid vs solid) and drug treatment (saline [0.9% NaCl] solution vs cisapride) on esophageal pressure profiles. We hypothesized that cisapride, a 5-hydroxytryptamine 4 receptor agonist, would increase LES tone as a result of its effects on gastrointestinal smooth muscle.16,17 As in studies of HRM performed in humans,18–22 our intent was to establish a set of variables to guide interpretation of canine deglutitive physiology.
Supported in part by the Comparative Gastroenterology Society (CGS) and Students Training in Advanced Research (STAR) Program at the School of Veterinary Medicine, University of California-Davis.
Dr. Conklin is a consultant and speaker for Covidien. Presented in part as an oral presentation at the IGPS (Interdisciplinary Graduate and Professional Symposium) at the University of California-Davis in April 2014.
Esophageal contraction front velocity
Pharyngeal contraction front velocity
Esophageal contractile integral
High-resolution esophageal pressure topography
Lower esophageal sphincter
Pharyngeal contractile integral
Upper esophageal sphincter
ManoScan 360TM, Given Imaging Inc, Duluth, Ga.
ManoScan 360TM, calibration chamber, Given Imaging Inc, Duluth, Ga.
Oxymetazoline hydrochloride 0.05%, Major, Livonia, Mich.
Tetracaine hydrochloride ophthalmic solution USP, 0.5%, Bausch & Lomb, Rochester, NY.
Lidocaine hydrochloride jelly USP, 2%, Akorn, Lake Forest, Ill.
ManoScan acquisition software, Given Imaging Inc, Duluth, Ga.
Surflo winged infusion set, Terumo, Tokyo, Japan.
Hill's i/d, Hill's Pet Nutrition Inc, Topeka, Kan.
Compounded cisapride, North Carolina State University College of Veterinary Medicine, Veterinary Teaching Hospital Pharmacy, Raleigh, NC.
BD Insyte sterile catheter, Becton Dickinson Infusion therapy, Franklin Lakes, NJ.
Buretrol, Baxter HealthCare Corp, Deerfield, Ill.
3010 Syringe pump, Medfusion, Medex Inc, Duluth, Ga.
United States Pharmacopeia (USP) compounded preparation monograph, Cisapride, Compounded, Injection, Veterinary. 2016.
Analytical Research Laboratories, Oklahoma City, Okla.
Enzymatic cleaner, Metrex, Orange, Calif.
Cidex activated glutaraldehyde solution, ASP (Advanced Sterilization Products), Miami, Fla.
ManoView analysis software, Given Imaging Inc, Duluth, Ga.
E-sleeve function, ManoView analysis software, Given Imaging Inc, Duluth, Ga.
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